If one or both testicles are not in the scrotum after the birth of a child, this is a developmental disorder, undescended testicles . Such undescended testicles almost always require medical treatment.
What is undescended testicles?
According to abbreviationfinder, about 1-3% of all male infants and 30% of all premature babies are affected by undescended testicles. Undescended testicles are a developmental disorder in which either one or both testicles have not descended into the scrotum. Usually, the testicles migrate into the scrotum around the seventh month of pregnancy.
It is possible that within the first year of life a delayed, independent migration of the testicles into the scrotum takes place. In general, a distinction is made between 3 forms of undescended testicles:
Groin testicles: The abdomen and scrotum are connected by the inguinal canal, this is where the testicles are located in this case
Sliding testicles: The testicle is repeatedly pulled back into the inguinal canal due to the fact that the spermatic cord of the testicle is too short
Abdominal testicles: It is not possible to feel the testicles because they are in the abdominal cavity
The pendulum testicle must be distinguished from these forms. The pendulum testis is not a disease but a reflex displacement of the testicles from the scrotum into the inguinal canal, this is not an undescended testicle.
Undescended testicles can have both an anatomical and a hormonal cause. For example, there may be an inguinal hernia or the inguinal canal is too narrow so that the testicles cannot move into the scrotum.
Due to hormones, the development of the child in the womb can be delayed, which also affects the migration of the testicles. In principle, the testicles in unborn babies develop in the kidney area.
Since the temperature outside the body, in the scrotum, is optimal for sperm production, the testicles migrate into the scrotum during development. Often, however, no clear cause is found for undescended testicles.
Symptoms, Ailments & Signs
The main symptom of undescended testicles after birth are testicles that have not completely descended from the abdominal cavity. One or both testicles can be affected. The testicles can either be perceived in the entrance area of the scrotum or not at all. There can be different forms of undescended testicles, the symptoms of which can vary.
The abdominal testicles (cryptorchidism) cannot usually be felt at all. Although a pendulum testicle is in the scrotum, it migrates back into the groin, for example when it is cold. A groin testicle can be felt in the groin, but cannot be guided into the scrotum. In contrast, a sliding testicle can be inserted into the scrotum, but returns from there to the groin area.
Testicular dissection is extremely rare. This means that the testicle is not on its natural path, but rather in the thigh or on the perineum. Although the testicles are not positioned correctly, they are normally formed and developed normally. In childhood, undescended testicles are not associated with any other symptoms.
If it persists beyond that, this can lead to a number of late effects. Above all, there is a risk of infertility. Testicular cancer can also occur. Affected adults also complain of pain in some cases.
Diagnosis & History
During the U1 examination of the newborn, undescended testicles can be diagnosed by a pediatrician. In order to be able to make a diagnosis, the doctor feels the scrotum while the child is in a standing, sitting and lying position.
If the doctor is unable to feel the testicles, a hormone stimulation test is carried out, which is used to detect testicular tissue. Further diagnostic methods are carried out with the help of a laparoscopy as well as with MRT and ultrasound. However, these procedures are not carried out regularly in the case of undescended testicles.
Undescended testicles treated too late can have various serious consequences over time. Testicular tissue that is already damaged can lead to infertility. This occurs in about 30% of those affected. Undescended testicles also increase the risk of an inguinal hernia and later developing testicular cancer.
If undescended testicles are not treated medically in good time, there is a risk of serious complications as they progress. These usually show up in adolescence. Babies and children rarely experience the immediate effects of undescended testicles, such as hormonal imbalances or pain. Although the testicles do not fit properly, they are normal.
However, adolescents who develop sexual awareness are at risk of psychological distress if one or both testicles are not in the scrotum. As a rule, however, undescended testicles are treated before the first birthday, so this is rarely the case.
Without therapy, there is a risk of sequelae in adulthood, including testicular torsion (rotation of the testicles). Torsion of the testicles on the spermatic cord is often caused by the testicles being in the wrong position. As a result, there is a risk that the vessels supplying the testicles will be pinched off, so that the testicle can die without prompt treatment.
In the case of an inguinal or gliding testicle, some sufferers develop weak points within the inguinal canal. This, in turn, makes it possible for intestines to burst out of the abdominal cavity, which doctors call an inguinal hernia.
Another complication is infertility. If the maldescensus testis is only present in one testicle, this has hardly any effect. However, if both testicles are affected, significantly fewer children are fathered. Furthermore, undescended testicles can have a favorable effect on testicular cancer. Without treatment, the risk of cancer increases twenty-fold.
When should you go to the doctor?
Undescended testicles are usually diagnosed by the pediatrician immediately after birth and treated immediately. Medical treatment is required at the latest when the testicles are in the wrong position causing pain or other symptoms. Parents who notice such signs in their child are best advised to speak to the pediatrician. If serious complications develop, the child must be treated in the hospital. Parents should arrange for an examination to minimize the risk of long-term effects such as infertility or testicular cancer.
People who had undescended testicles diagnosed and treated as children should continue to visit their family doctor or a urologist regularly later in life. A comprehensive examination will ensure that the testicle is positioned correctly and is not causing any problems. In addition, any triggers such as hormonal fluctuations can be identified and corrected at an early stage before the testicles become undescended. If the malposition is due to a serious illness, close monitoring by a specialist is required. Treatment usually takes place in a specialist urology clinic.
Treatment & Therapy
If the testicles do not lower themselves within the first six months of life due to undescended testicles, treatment by a urologist is recommended. However, before an operation is performed, a hormone treatment should be carried out. In hormone therapy, the hormone gonadotropin is administered. It is intended to ensure that the testicle moves (further) into the scrotum.
The hormone can be absorbed through the mucous membrane in the form of a nasal spray or injected intramuscularly. Hormone therapy for undescended testicles is successful in 20% of all cases. There are exceptions where surgery should be performed. These exceptions include:
- undescended testicles during puberty
- Simultaneous hernia
- Unsuccessful hormone therapy
- Abnormal positioning of the testicle
During an operation, the testicles are surgically relocated into the scrotum and sewn there at the deepest point. If the testicle is already atrophied, it is removed to avoid further consequential damage. In any case of undescended testicles, regular check-ups are necessary from the age of 15.
Outlook & Forecast
In rare cases, within the first year of life, the affected testicle can migrate into the scrotum on its own without treatment. However, as you get older, this becomes less and less likely. The earlier the undescended testicles are treated surgically or hormonally, the lower the risk of long-term complications or secondary diseases.
The prognosis for hormone therapy is significantly better if the affected testicle has already migrated towards the scrotum. Hormonal therapy is successful in about 20 percent of those affected. However, about 25 percent of the testicles that were initially successfully treated migrate back up out of the scrotum after hormone therapy. With surgical treatment, the prognosis is significantly better. In five percent of those affected, the treated testicles still move upwards after the operation.
Consequential damage from undescended testicles or the operation rarely occurs. The testicles may have been damaged and dysfunctional even before successful treatment. Atrophy of the testicles can also occur after an operation. If neither hormonal nor surgical treatment is successful, surgical removal of the testicles is often recommended because there is an increased risk of cancer. Even after successful treatment, the likelihood of developing testicular cancer is slightly higher.
Since undescended testicles are a developmental disorder, there are no preventive measures. Only long-term effects can be avoided by treating undescended testicles with early check-ups.
If the undescended testicles are treated surgically, a grace period must be observed after the procedure. For optimal wound healing, the patient should stay in bed for two days and rest. Physical activities should be avoided during this time. Bed rest can take place in the hospital as an inpatient or as an outpatient at home.
Even after successful surgical or hormonal treatment, the testicles can get high again. A so-called atrophy, atrophy of the testicles, is also possible. In order to be able to record these possible complications, close monitoring is recommended. Follow-up examinations should be carried out every three months.
An ultrasound is used to assess the size and position of the testicles. If the status of the testicles is not satisfactory six months after the end of the therapy, the patient usually has to present himself to the treating surgeon again. If the findings are normal, further follow-up checks are necessary every three months to a year after the operation.
In addition, patients should return for follow-up after the age of fifteen. Here, those affected are examined for malignancies on the testicles. The examination can be carried out by the attending pediatrician. Alternatively, family doctors and urologists can also take over this care.
In addition, according to the S-2 guideline, it is recommended that the young people examine themselves at regular intervals. Any enlargement of the testicles should be reported to a medical professional immediately. This is especially the case when the enlargement occurs without pain.
You can do that yourself
If undescended testicles were found in the child, medical treatment is required. The hormone therapy that takes place first can be supported by alternative methods from naturopathy and homeopathy in consultation with the doctor.
However, the most important measure is the observation of the child. The behavior of the child shows relatively quickly whether the hormone therapy is successful, because a lowering of the testicles is often noticeable through a reduction in pain. The affected testicles should be checked regularly by a doctor, because this is the only way to ensure that a descent actually takes place.
If the undescended testicles persist despite hormonal treatment, an operation must be performed. Since this is a routine procedure, the child does not need to be specially prepared for it. It is important to take away any fears the child may have and to make the time in the hospital as pleasant as possible. The developmental disorder should be discussed with older children, preferably together with the pediatrician, who can explain the reasons for the disorder to the person concerned and at the same time allay fears about surgical intervention.
After the operation, the child should stay at home for a few days and take it easy. Sporting activities in particular should be avoided in the initial period after an operation.